POS0109 IMPACT OF EARLY AGE AT MENOPAUSE ON DISEASE OUTCOMES IN POSTMENOPAUSAL WOMEN WITH RHEUMATOID ARTHRITIS: RESULTS FROM A LARGE OBSERVATIONAL COHORT OF KOREAN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: E. H. Park, S. T. Choi, J. S. Song, E. H. Kang, Y. J. Lee, Y. J. Ha
Journal: Annals of the Rheumatic Diseases (2022)

Background The increased prevalence of rheumatoid arthritis (RA) in women has led to studies exploring how female reproductive factors affect disease outcomes in women RA. While a few studies have investigated how early menopause (EM) affects RA outcomes, they had relatively small sample size and have shown inconsistent results [1, 2]. Moreover, none has evaluated the association between age at menopause and longitudinal changes in validated disease activity indices or patient-reported outcomes (PROs) of RA. Objectives We aimed to assess the differences in clinical outcomes between RA patients with EM (age at menopause &lt;45 years) and usual menopause (UM) (age at menopause ≥45 years), and identify potential impact of EM on longitudinal changes in RA activity and PROs during follow-up period. Methods A total of 2,878 postmenopausal women with RA were included from the Korean Observational Study Network for Arthritis, a nationwide prospective RA cohort of Korea. Each patient was examined at baseline and for 5 consecutive years using the simplified disease activity index (SDAI), health assessment questionnaire-disability index (HAQ-DI), and other PROs. Among patients with a baseline SDAI &gt;11, generalized estimating equation (GEE) analyses were performed to evaluate the impact of EM on longitudinal changes in RA activity and PROs during follow-up. Results The EM group (N=437) was younger than the UM group (N=2,441) [58.0±9.5 vs. 60.8±8.0 years, p&lt;0.001], but RA duration was similar between the two groups. The EM group had higher education level and was more likely to be seronegative at enrollment. Moreover, the EM group demonstrated higher disease activity [SDAI 15.4±11.7 vs. 13.9±10.0, p=0.011] and patient-reported visual analogue scale (VAS) scores for global assessment, fatigue, and sleep disturbance (all p&lt;0.05), and worse EQ-5D-VAS [59.9 ±22.2 vs. 63.0±19.5, p= 0.006] at baseline. The rate of previous fracture and neoplastic disease, especially uterine/cervical neoplasm, was higher while that of hypertension was lower among the EM group. The GEE model revealed that EM significantly influenced the rate of SDAI change (β=1.265, p=0.004), after adjusting for age, RA duration, biologic use, and SDAI at baseline. The EM group was also significantly associated with increase in HAQ-DI (β=0.088, p=0.003), and decrease in EQ-5D utility value (β=-0.031, p=0.016) during 5-year follow-up period. Conclusion RA patients with EM demonstrate higher disease activity and poorer health-related quality of life. EM significantly affects longitudinal changes in disease activity and PROs in RA. References [1]Pikwer M, Nilsson JA, Bergstrom U, et al. Early menopause and severity of rheumatoid arthritis in women older than 45 years. Arthritis Res Ther. 2012 Aug; 14(4):R190. [2]Wong LE, Huang WT, Pope JE, et al. Effect of age at menopause on disease presentation in early rheumatoid arthritis: results from the Canadian Early Arthritis Cohort. Arthritis Care Res (Hoboken). 2015 May; 67(5):616-623. Table 1. Longitudinal analysis of predictors of the SDAI, HAQ-DI, and EQ-5D utility value over time using a GEE model among patients with a baseline SDAI &gt;11 Outcome Independent variables Regression coefficient (β) (95% CI) P SDAI Age 0.013 (-0.024-0.049) 0.503 RA duration 0.084 (0.046-0.122) &lt;0.001 Baseline SDAI 0.580 (0.531-0.630) &lt;0.001 Biologic use 0.196 (-0.924-1.315) 0.732 Early menopause 1.265 (0.412-2.117) 0.004 Follow-up time -1.806 (-1.964--1.647) &lt;0.001 HAQ-DI Age 0.007 (0.004-0.009) &lt;0.001 RA duration 0.011 (0.009-0.014) &lt;0.001 Baseline HAQ-DI 0.674 (0.638-0.711) &lt;0.001 Biologic use 0.044 (-0.033-0.122) 0.264 Early menopause 0.092 (0.030-0.154) 0.003 Follow-up time -0.004 (-0.016-0.007) 0.457 EQ-5D Age -0.002 (-0.003--0.000) 0.007 RA duration -0.003 (-0.004--0.002) &lt;0.001 Baseline EQ-5D utility value 0.532 (0.492-0.572) &lt;0.001 Biologic use -0.012 (-0.045-0.021) 0.489 Early menopause -0.033 (-0.059--0.006) 0.016 Follow-up time 0.010 (0.005-0.015) &lt;0.001 Disclosure of Interests None declared